Starting with Planck scale it is developed the Relativistic Radial Density Theory (RRDT). In this theory, the Planck and gravitational parameters can be described as the functions of the radial mass (energy) density value. This density is maximal at the minimal radius and minimal at the maximal radius. This conclusion is based on the fact that the ratio of Planck mass and Planck length (radius) is constant. These radiuses can be described as the function of the energy conservation constant κ. Using RRDT, it is possible to develop the connections between Planck’s and gravitational parameters as function of the maximal and minimal radial mass (energy) density values. In that sense, the gravitational length, time, energy and temperature can be presented as the function of the Planck length, time, energy and temperature, respectively. This opens possibility to merge of Quantum Field Theory (QFT) and the General Theory of Relativity (GTR) at the quantum scale in gravitational field. The existence of the maximal radial mass (energy) density value at the minimal radius in gravitational field means that no singularity in that field. Further, the existence of the minimal radial mass (energy) density value at the maximal radius in gravitational field means that no infinity in that field. It follows the postulation: the most minimal radius in a gravitational field belongs to the minimal mass (energy). Since the Planck mass is not the minimal mass in space-time, the Planck length/radius is not the minimal length/radius in the space-time. If the calculated minimal (or maximal) radius is the bigger than the related official radius it means that there exists a dark matter in this object. In that sense, the black holes are presenting the state of the matter at the minimal radius where we have the maximal radial mass (energy) density value. Further, the maximal possible radius of the matter is presenting the state with the minimal radial mass (energy) density value. Thus, the maximal and minimal radial mass (energy) density values are constants and conserved items. Now the question is: do motion of the Universe follows the RRDT?

Proper and effective management of obstructive sleep apnea (OSA) in elderly patients represents an important yet under-researched therapeutic target. Therefore, the main purpose of our research was to employ age stratification to analyse sleep quality and sleep fragmentation, the daily sleepiness, OSA severity and CPAP compliance in elderly. Conforming to the inclusion criteria of minimum 70 years of age at the time of polysomnography and CPAP titration night a total number of 162 elderly patients was included, median age 73,00±4 (MED±IQR). The comparison group consisted of 448 adult subjects under the age of 70 years old, median age 54,00±14,00 (MED±IQR). Sleep fragmentation in elderly was promoted to suboptimal CPAP adherence, as the probability of CPAP use ≥ 4 hours per day was less than 20%. Overall CPAP compliance hours in the elderly group achieved 3,991±3,804 hours/day with bigger variation in between the subjects versus 5,547±3,465 hours/day for the controls, (MED±IQR, p<0,001). Despite naturally occurring sleep fragmentation worsened by OSA, less than 30% of elderly patients would score ≥ 10 points on Epworth sleepiness scale. The study emphasizes acute need for standardized age-specific diagnostic tools to address different perception of daily drowsiness and sleepiness by older people. Further, it underlines the importance of early recognition of possible comorbid OSA and insomnia and suggest paying more attention to “non-obese phenotype” in the subgroup of elderly patients with suspected OSA. Elderly patients might also need development of more flexible CPAP compliance criteria; however, those must be standardized and objective.

Background: The sacroiliac joint (SIJ) plays a crucial role in transmitting axial loads and maintaining pelvic stability. Sacroiliac joint arthropathy (SIJA) accounts for 10%–30% of low back pain cases but remains underrecognized due to overlapping pain referral patterns and nonspecific imaging findings. Diagnosis relies primarily on characteristic pain distribution and provocative maneuvers, with image-guided intra-articular block serving as the diagnostic gold standard. This study aimed to characterize the clinical profile of block-confirmed SIJA, emphasizing referral pain distribution, triggering position, and provocative test responses. Methods: A cross-sectional study was conducted on 98 patients with diagnostic block–confirmed SIJA at Siloam Hospital Lippo Village, Indonesia. Demographic data, referral pain sites, sitting duration, and results of FABER, compression, and distraction tests were analyzed descriptively. Results: The mean age was 52.07 ± 14.17 years, with 72.4% females. Referral pain most frequently involved the lower back (28.6%) and thigh (28.6%), with occasional extension to the groin (8.2%) or calf (4.1%). Over half of patients (55.1%) reported sitting more than six hours daily. Pain was predominantly triggered during sit-to-stand transitions (85.7%) and while sitting (74.5%). SIJ tenderness (98.0%) and FABER positivity (75.5%) were most consistent. Conclusion: The dominant referral pain in SIJA involves the lower back and posterior thigh. Sit-to-stand transition is the most frequent triggering position, while FABER testing demonstrates the highest diagnostic yield among provocative maneuvers. These consistent patterns may serve as practical clinical indicators to improve diagnostic accuracy in suspected SIJ-related pain.

Nodal marginal zone lymphomas are indolent and rare non-Hodgkin lymphomas, most often diagnosed at an advanced stage. Their clinical presentations are typically insidious, which can lead to delayed diagnosis. The concomitant secretion of IgM and IgG immunoglobulins with kappa light chains constitutes an exceptional feature in this type of lymphoma, as illustrated by our case. We report the case of a 62-year-old man with a history of treated syphilis and inferior vena cava thrombosis managed with rivaroxaban, who presented with a left inguinal mass evolving over three months, accompanied by fever, night sweats, and weight loss. Clinical examination revealed non-inflammatory left inguinal lymphadenopathy without other abnormalities. Laboratory tests showed non-regenerative anemia, leukopenia, and elevated LDH levels. Protein electrophoresis revealed a monoclonal peak in the gamma region, confirmed by serum immunofixation showing two monoclonal bands of IgG kappa and IgM kappa types. Biopsy of the inguinal lymph node revealed histological and immunohistochemical features consistent with a small B-cell marginal zone lymphoma, staged as IV based on the extension workup. A chemotherapy regimen consisting of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) was initiated, resulting in a partial response after four cycles. The coexpression of IgM and IgG kappa light chains in nodal marginal zone lymphomas, which are already rare, is an unusual finding. This particularity warrants multicenter studies to better assess its diagnostic, prognostic, and therapeutic implications.

Delirium is a major complication most commonly observed in patients with advanced cancer. However, despite its prevalence, the early diagnosis, management, and prevention of this condition have not seen significant progress. Aim of this research is to provide insights into the prevalence of delirium, the optimization of interventions for managing delirium symptoms, their effectiveness and the impact of underlying factors on the reversibility of delirium in advanced cancer patients receiving palliative care. The review involved systematic searches of relevant databases including MEDLINE, CINAHL, ProQuest Nursing and Allied Health, and PsychInfo using refined search terms. Eight publications out of 614 studies originally searched were selected and critically reviewed. Their quality was assessed using Joanna Briggs Institute's Critical Appraisal Tool for Case Series. Data abstraction and content analysis were performed to synthesize the findings. Delirium is prevalent among advanced cancer patients in palliative care, with rates ranging from 10.3% to 24.1%. Pharmacotherapy and non-pharmacological interventions showed effectiveness in reducing delirium symptoms. Delirium was found to be reversible through palliative care interventions, antipsychotic medications, and exercise therapy. Effective delirium management is crucial in improving the quality of life of cancer patients. This review emphasizes the importance of subtype-specific treatments, standardized guidelines, and long-term follow-up studies. Implementing evidence-based individualized approaches to delirium management can optimize treatment efficacy and clinical outcomes in patients as well as improve the quality of care. Tailored interventions, standardized protocols, and further research are hereby recommended.

The purpose of this study was to examine the influence of new religious movements’ televangelism on women in Dunkwa-on-Offin in the central region of Ghana. The study adopted the sequential explanatory mixed-methods approach. The study population was important because they make up a bigger share of individuals who attend mainline churches and are constantly exposed to televangelism in their daily lives. A multi-stage sampling technique (purposive and simple random sampling techniques) was used to select two hundred (200) women for the study. Krejcie and Morgan's table determined the two women population of 400 (for both churches). The main instruments for data collection were questionnaires and interview guides. Quantitative data was analysed with the use of the IBM SPSS statistics software version 23, to compute frequency distributions, percentages, tables and cross-tabulation. Descriptive statistics and inferential analysis were employed in the analysis of the data. Qualitative data was analyzed thematically by identifying relevant information, coding, classification and summaries. The study revealed that televangelism has influenced women to follow televangelists rather than the teachings of their churches. Also, the activity has influenced the youth and women to follow false teachings, prosperity and vain promises of travelling. The findings of the study revealed that televangelists’ messages are geared towards obtaining money and raising unrealistic hopes. It is recommended that the government should also establish and enforce policies and regulations that encourage genuine televangelism programming and deter televangelists who are driven by fraud and self-gain by registering all the churches and holding them accountable for their actions.

Currently, Drug Counterfeiting is the biggest challenge facing the pharmaceutical industry. They are encountering this threat due to high market demand for the drugs and their profit margin. The lack of data transparency and traceability also lured criminals into the counterfeiting of drugs which, is impacting people’s health and put their life in danger. Through the drug supply chain, a substantial portion of counterfeit drugs are injected and distributed through the healthcare supply chain network, so the supply chain plays a vital role in drug distribution and impacts patient lives. Through digitalization in the healthcare sector, Distributed Ledger Technology (DLT) provides a platform with ground-breaking results by providing a system for drug traceability with consideration of the critical requirements of transparency, privacy, and authenticity without involving any third party. In DLT, each distribution partner is registered to maintain transparency with the drug information. Real-time transfer of information about the change of ownership with date and time in the form of blocks gives visibility to all the partners in real time about the authenticity of drugs. This article will give information about the benefits of Distributed Ledger Technology to the pharmaceutical industry and the traceability of drugs from end-to-end of the pharmaceutical supply chain.

Background: Neck pain is one of the most common reasons patients seek treatment in the hospital. The causes of neck pain vary widely, trigger misdiagnosis, and often result in mistreatment. Misdiagnoses and mistreatment-related neck pain diagnoses are often associated with a diagnosis of cervical herniated disc. The implication of the misdiagnosis is the use of excessive investigations and inappropriate therapy. This review aims to determine the causes of neck pain often obtained in daily practice and how to diagnose and treat it. Method: Search relevant articles on clinical diagnosis of neck pain with the keywords neck pain diagnostic therapy using Medline and PubMed databases. Results: Neck pain can be in the form of axial pain, which is mostly related to disorders of the joints and muscles of the neck, or in the form of pain in the roots and spinal cord. Investigations and therapy must be related to the clinical diagnosis of neck pain experienced by patients with a history of neck pain. Conclusion: Neck pain is one of the most common complaints encountered in outpatient department settings, associated with reduced quality of life. Patients may come with differing degrees of pain, various symptoms, and aetiologies making it quite challenging to treat them into complete remission. Despite being frequently encountered, some patients with neck pain are underdiagnosed and undertreated due to failure to understand the clinical symptoms before deciding possible aetiologies.

Psoriasis is a multi-systemic chronic autoimmune inflammatory disorder affecting 125 million people worldwide. The most common type of psoriasis is plaque psoriasis affecting up to 90% of the patients and is characterized by well-demarcated, symmetric, and erythematous plaques with overlying silvery scales that may be painful or itchy. Psoriasis may also affect the joints; increase the risk of developing metabolic syndrome, diabetes, Crohn’s disease, ulcerative colitis, uveitis, certain cancers and an increase in the risk of cardiovascular diseases. Both the skin and the gut microbiome can modulate the development and progression of psoriasis. A connection between the microbiome and immunological mechanisms are antimicrobial peptides, which regulate the microbiome at interfaces and, as antigens, can trigger psoriasis. Few studies were conducted to demonstrate the effect of probiotics on different diseases, as they are living microorganisms that confer a health benefit when administrated in adequate amounts. The effects of administering probiotics include the stabilization of the gut bacterial community and the restoration of “signature” of bacterial microbiota, which is a result of lowering the pH, producing bacteriocins, altering microRNA (miRNAs), competing with pathogens for certain nutrients and improving the gut barrier function. Probiotics counter weight aggressive commensals in the body and reinforce the barrier function of the epithelium while also contributing to the regulation of innate and adaptive immune responses of the host under healthy or pathogenic conditions. Several clinical trials were conducted based on those findings to examine the role of probiotics in psoriasis, but till now there is no evidence of their efficacy.

This paper addresses the labial-palatalization process in Akuapem, a dialect of Akan. In this paper, we study the labial-palatalization, and the tonal processes related to the verbal prefix bɛ when cliticized to reduplicative verbs in the Akuapem dialect of Akan. Based on labial-palatalization, it is not all the Akuapem dialect that labial-palatalizes a C in a CUa/e string that triggers the labial-palatalization process. The study also concluded that when the verbal prefix or the modal marker bɛ is cliticized to reduplicated class I verbs, all the reduplicant and the base form of the verb assume different tonal melody in all the sub-dialect of Akuapem.

The purpose of the study was to examine the Motives of Tourists; Socio-Economic and Challenges of tourism in Kwahu in the Eastern Region of Ghana The study adopted a descriptive survey research design. The population of the study comprised six (6) communities (Mpraeso, Atibie, Obomeng, Obo Oworobong, and Nketepa in Kwahu South District Assembly (KSDA) in the Eastern Region of Ghana. Purposive and convenient sampling techniques were employed to select two hundred (200) respondents for the study. The main instrument used for data collection was questionnaires. The study employed the statistical package for social sciences (SPSS) to code and process the collected data. Descriptive and relational statistical techniques involving frequencies, percentages, summations, diagrams, and tables were employed in analysing the data. The Chi-square test analysis was used to explore the relationships and differences in perceptions. The study indicated that every tourist, whether local (Ghanaian) or foreign, had at least one of the following motives in mind for participating in the festival; To socialize; For relaxation; For education to participate and witness the paragliding festivals; To take photographs of festival scenes; Other motives like to sell items, especially souvenirs. The study also revealed that the KEF has had some positive socio-economic impact or implications on the area. These among others include: job creation, income generation for locals of the area, infrastructural development, and projection of the image of the area as the festival has become one of the biggest gatherings of revellers in the country, drawing people from all walks of life, nationally and internationally as a result of the introduction of paragliding since 2005, socialization enhancement, medium for cultural exchange and education, and finally serves as a medium for portraying the cultural identity of the people of Kwahu. The study also indicated that the major challenges encountered by tourists during the event were listed in order of degree of intensity: High cost of living, poor road network in the area, intermitted electricity and water supply, poor sanitary conditions in the area, poor health facilities, and unwelcoming attitude of some local residents of the festival area. It is recommended that, residents must be educated about the potential benefits of tourism as an industry helping to achieve sustainable community development. It is also recommended that Ghana tourism authority and Kwahu District Assembly should collaborate to improve on social amenities in the municipality to attract more foreign and local tourists during the festivity.

Background: Vascular thrombotic events such as pulmonary embolisms have been frequently reported in the course of SARS-Cov-2 infection. However, sagittal sinus thrombus is extremely rare, and patients may lack other appealing Covid-19 infection symptoms. Case report: 46-year-old female with past medical history of Hyperlipidemia, Hypertension presented to Emergency room with headache, chest pain, vomiting. SARS-CoV-2 IgG Antibodies were reactive. Except for elevated PTT-Lupus Anticoagulant at 50 Sec, Hypercoagulable workup was negative. The MRI venogram findings were consistent with the Dural thrombus of superior sagittal sinus. Patient subsequently developed chest pain, and Computed tomography angiography found pulmonary emboli within segmental branches of the right lower lobe pulmonary artery. Patient was managed in the ICU with Heparin and switched to Coumadin for discharged. Conclusion: The incidence of Cerebral Venous Sinus thrombus (CVST) among Covid-19 patients is inferior to 0.02%. And most of the patients lack typical Covid-19 presentations such as pneumonia. The lack of symptoms may promote the insidious course of pre-thrombotic events that lead to CVST. However more Retrospective studies are necessary to established consistent odd ratios. Due to the higher mortality associated with CVST and the ongoing of Covid-19 pandemic, we recommend a higher level of clinical suspicion.

Astronomic azimuths had been used for orienting old surveys in Ghana. With technological advancement and the development of simpler but accurate equipment and techniques for measurement, this has been replaced by the use of the Global Navigational Satellite System (GNSS) techniques such as the Global Positioning System(GPS). However, the use of these for azimuth determinations results in a different type of azimuth as opposed to astronomic azimuths previously used. For retracing some of those old surveys based on Astronomical coordinates, the relationship and convertibility between the different azimuths is imperative. In this exploration, the relationship and precision of both techniques were tested on various baselines located in different parts of the country. This involved the computation of Astronomic, Geodetic and Grid Azimuths between pairs of points to form several baselines. These baselines span from the Southern to the Middle belt portions of the Country where triangulations have been done, as some of these triangulation stations were Laplace stations that have both astronomic and geodetic coordinates determined for them. The results were investigated in terms of effect of using the convergence and t-T correction to convert between the set of azimuths. The results show that Geodetic Azimuths could be converted to grid coordinates and vice versa to accuracies of mean 0° 0ʹ 0.56ʺ and standard deviation ± 5.6 seconds. However, for Astronomic to Grid Azimuths, without correcting for Deflection of vertical, the conversion is accurate only to mean differences of 0° 1ʹ 25.3ʺ with standard deviation ± 0° 8ʹ 21.5ʺ. The results show the necessity of the Laplace correction for vertical deflection in astronomic azimuths in addition to the convergence and t-T correction and recommends the provision of country-wide deflection corrections.

The purpose of the study was to investigate the factors contributing to domestic violence in Koforidua in the New Juaben Municipality of Ghana. The population of the study consisted of 340 men selected from four communities in Koforidua. Purposive sampling technique 4 communities. Using the Krejcie and Morgan table, a sample size of 340 men were selected which is appropriate for a population of 3428 with an alpha level of 5 percent in a quantitative study. The selection was based on the fact that these communities registered the highest cases of domestic violence in the Municipality. The main instrument used for the study was structured questionnaire. Data analysed using SPSS (Statistical Product for Service Solution, version 20). Statistical tools such as frequency distribution tables, percentages, charts and cross tabulation was used. The frequency tables were used to give the summary of the data for easy understanding and comparison. The study revealed that men perceive that factors like show of power, exposure to domestic violence, poor communication in marriage, unemployment and poverty, control of women through discipline and women’s low academic achievement are the triggers of domestic violence in a marital relationship. The study recommended that effort ought to be put in place to unravel the mystery surrounding male supremacy over women at both institutional and community levels by DOVVSU, Gender Advocacy Groups and other institutions to benefit humanity and society at large.

A 75-year-old female is referred for evaluation of a progressive leg swelling. Angiological and MRI evaluation show the presence of inflammatory tissue surrounding the aorta and the left iliac vessels, causing significant stenosis. Upon suspicion of retroperitoneal fibrosis, we actively seek for secondary causes such as malignancies, autoimmune diseases and infections, as well as IgG4-related disease. All investigations result negative and we make the diagnosis of idiopathic retroperitoneal fibrosis. Steroid therapy was started and we observed a rapid amelioration of symptoms and radiological disappearance of the inflammatory tissue around the aorta.

Major depressive disorder is characterized, among other symptoms, by depressed mood and anhedonia associated with a high rate of suicidal ideation. In recent years, research has shown reduced expression of the brain-derived neurotrophic factor (BDNF) in limbic areas of individuals with depression. This reduction of BDNF is reversed by antidepressants in animal models of stress. Stress is one of the main triggers of mood disorders such as depression. Also, administration of BDNF increases the number of serotonergic fibers and serotonergic innervation, indicating an increase of serotonin in the synaptic cleft by this neurotrophin. Thus, BDNF appears to be one of the targets of antidepressant drugs for the increase of monoamines and remission of symptoms of major depression. The purpose of this review was to show the evidence that indicates BDNF as a molecular substrate for vulnerability to depression and the response of this substrate to the antidepressants.

Introduction: Concurrent infections or co-infections in patients diagnosed with Coronavirus Disease-19 (COVID-19) are not uncommon and predict a pejorative prognosis. A co-infection accounts for 1 out of every 5 cases of COVID-19 and increases the likelihood of adverse health outcomes such as mechanical ventilations, ICU admissions, and death. Specifically, Legionella spp. co-infection presents additional challenges in COVID-19 patients because of its rarity, similar clinical presentation to SARS-CoV-2, and poorer outcomes without prompt treatment. Cases Presentation: Case 1. A 62-year-old female presented with a 3-day history of subjective fever and worsening shortness of breath. Room air saturation (saO2) was 70% and improved to 100% on noninvasive positive- pressure ventilation (NIPPV). Lung auscultation revealed rales BL. Chest X –Ray (CXR) showed patchy airspace opacities bilaterally (BL), SARS-CoV-2 PCR and urine legionella antigen tests were positive. The diagnosis of hypoxic respiratory failure secondary to COVID-19 and Legionella pneumonia was made. Patient was admitted to intensive care unit (ICU) and managed with decadron, remdesivir, one unit of convalescent plasma for COVID-19 and Azithromycin for Legionella. Patient subsequently developed acute respiratory distress syndrome (ARDS). ARDS protocol was initiated. 13 days after, the patient was compassionately extubated. Case 2. A 41-year-old male presented with 5-day history of fever, worsening shortness of breath, cough and diarrhea. Patient admitted history of ethanol abuse. SaO2 was 88% and improved on oxygen canula. Lung auscultation revealed rhonchi BL. CXR showed extensive left lung consolidation. Urine test for legionella antigen was positive. COVID-19 PCR was negative, but SARS-CoV-2 IgG was reactive. The diagnosis of Legionnaire disease was made. Despite initial treatment with Azithromycin, patient's hypoxia continued to worsen requiring NIPPV, and subsequently mechanical ventilation in the ICU. The adjunction of empiric treatment for COVID-19 with convalescent plasma, remdesivir and steroids improved both clinicals and laboratory findings. Discussion: The cases illustrated the practical challenges of managing COVID-19 and legionella co- infection. Legionella spp and SARS-CoV-2 overlapping incubation periods and similar clinical presentations and complications. In the absence of diagnosis and treatment, legionella pneumonia has an intrinsic mortality rate of up to 80%. As some COVID-19 mitigation strategies, such as the closure of businesses, have enhanced the conditions for Legionella spp proliferation, the incidence of Co-infection with COVID-19 may increase. We recommend clinicians to have high-indexed suspicion of COVID-19 and Legionella co-infection in order to obtain complete work up at patient’s initial presentation.

To ensure maximum flexibility, service providers offer a variety of computing options with regard to CPU, memory capacity, and network bandwidth. At the same time, the efficient operation of current cloud applications requires an infrastructure that can adjust its configuration continuously across multiple dimensions, which are generally not statically predefined. Our research shows that these requirements are hardly met with today's typical public cloud and management approaches. To provide such a highly dynamic and flexible execution environment, we propose the application-driven autonomic management of data center resources as the core vision for the development of a future cloud infrastructure. As part of this vision and the required gradual progress toward it, we present the concept of composable infrastructure and its impact on resource allocation for multi-cloud environments. We introduce relevant techniques for optimizing resource allocation strategies and indicate future research opportunities [1]. Many cloud service providers offer computing instances that can be configured with arbitrary capacity, depending on the availability of certain hardware resources. This level of configurability provides customers with the desired flexibility for executing their applications. Because of the large number of such prerequisite instances with often varying characteristics, service consumers must invest considerable effort to set up or reconfigure elaborate resource provisioning systems. Most importantly, they must differentiate the loads to be distributed between jobs that need to be executed versus placeholder jobs, i.e., jobs that trigger the automatic elasticity functionality responsible for resource allocator reconfiguration. Operations research reveals that the optimization of resource allocator reconfiguration strategies is a fundamentally difficult problem due to its NP-hardness. Despite these challenges, dynamic resource allocation in multi-clouds is becoming increasingly important since modern Internet-based service settings are dispersed across multiple providers [2].

The automation of IT Service Management (ITSM) workflows using explicit rules and data has been established for years. Domain-specific rule engines interpret rules written in declarative rule modelling languages and generate forwarding arrows to process event streams and support decision making. Such automation is augmented by rule-driven Quality Assurance for correctness, safety, and risk management. The service desk is the onshore base of an ITSM supply chain. An end-to-end incident response service resolves incidents using only onshore resources and employs back office teams to help with unresolvable incidents. The forward factories of rule-based automation for ticket processing service are identified. Several rule-based workflows in incident and change management have been published. Further glimpses of the future across all ITSM workflows are provided based on training in an online ITSM service with automated operations. Rule engines are specialised components that direct the processing of data flows according to pre-defined rules. Decision factories complement the more common event-driven rule engines. While event processing occurs below the polling frequency of the source, rules in decision factories are triggered based on the arrival of data. These factories are applied in ITSM for risk and safety evaluation and quality assurance. Rule-enriched architectures incorporate domain-specific modelling languages to ensure correctness with respect to qualitative quality attributes. Dedicated factories provide resilience, detect slack or over-utilisation, and offer point-in-time assurance and testing.